Memory Trajectories Before and After First and Recurrent Strokes.

Wentian Lu,Martin Bobak,Marcus Richards,David Werring

doi:10.1212/wnl.0000000000013171

Abstract

Background and ObjectivesEvidence on timing of memory change after first and recurrent strokes is limited and inconsistent. We investigated memory trajectories before and after first and recurrent strokes in 18 European countries and tested whether the country-level acute stroke care was associated with memory change after stroke.MethodsData were from the Survey of Health, Ageing and Retirement in Europe (2004–2019). Incident first and recurrent strokes were identified among baseline stroke-free individuals. Within each country, each participant with incident stroke (case group) was matched with a stroke-free individual (control group) using propensity score matching. We applied multilevel segmented linear regression to quantify acute and accelerated memory changes (measured by the sum score of immediate and delayed word recall tests; 0–20 words) before and after first and recurrent strokes in both groups. Associations between stroke and memory were compared between countries with different levels of acute stroke care indicators.ResultsThe final analytical sample included 35,164 participants who were stroke-free at baseline (≥50 years). A total of 2,362 incident first and 341 recurrent strokes between 2004 and 2019 were identified. In case groups, mean acute decreases in memory scores were 0.48 (95% confidence interval [CI] 0.31, 0.65) and 1.14 (95% CI 0.80, 1.48) words after first and recurrent stroke, respectively, independent of a range of confounders. No such acute decreases were observed in the control group after a hypothetical nonstroke onset date. In both groups, memory declined over time but decline rates were similar (−0.07 [95% CI −0.10, −0.05] vs −0.06 [95% CI −0.08, −0.05] words per year). The mean acute decreases in memory scores after first and recurrent strokes were smaller in countries with better access to endovascular treatment.DiscussionWe found acute decreases but not accelerated declines in memory after first and recurrent strokes. Improved endovascular therapy might be associated with smaller memory loss after stroke but more evidence based on individual-level data is needed. More effort should be made in early assessment and intensive prevention of stroke among the ageing population and promoting access to and delivery of acute stroke care among patients with stroke.

Highlights

As there is evidence of inequalities in access to, and delivery of, acute stroke care across European countries,[22] we investigated whether improved implementation of acute stroke care, is associated with less cognitive decline after stroke onset
Participants with incident stroke were more likely to come from countries with a ‘moderate to high’ level of Intravenous Thrombolysis (IVT) and Endovascular Treatment (EVT) care
In this large multi-country dataset, we found acute decreases in memory after incident first and recurrent strokes in comparison to matched stroke-free individuals, whereas memory decline rates were similar

Summary

Introduction

Cohort studies worldwide have suggested that following stroke there is cognitive decline affecting verbal memory, verbal fluency, temporal orientation, processing speed, executive function, and global cognition over time.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20] the exact timing of the association remains unclear. Several cohort studies have estimated cognitive transitions before and after first stroke; the results were mixed, perhaps due to disparities in cognitive measures. The evidence on timing of memory change after first and recurrent strokes is limited and inconsistent. We investigated memory trajectories before and after first and recurrent strokes in eighteen European countries, and tested whether the country-level acute stroke care was associated with memory change after stroke

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Results

Conclusion